Characteristics of the Superficial Circumflex Iliac Artery Perforator (SCIP) Flap in a Western Population and a Practice Approach for Free Flap Reconstruction
Martin J. Carney, III, MD1, Michael N. Mirzabeigi, MD2, Kristopher Tantillo, MD2, Jason M. Weissler, MD3, Charles Messa, IV, BS2, Tessa Cook, MD, PhD2, Stephen J. Kovach, MD2.
1Yale University, New Haven, CT, USA, 2University of Pennsylvania, Philadelphia, PA, USA, 3Mayo Clinic, Rochester, MN, USA.
BACKGROUND: There has been increasing interest in the SCIP flap as a source of thin, pliable soft tissue combined with a favorable donor-site. Despite several clinical series from Asia, barriers to adoption include reluctance to perform sub-millimeter "super-microsurgery" and the effect of body habitus on flap feasibility. The purpose of this study is to distinguish vascular anatomic characteristics of the SCIP flap in a North American population.
METHODS: Computed tomography angiography was performed to study a total of 84 vessels in healthy prospective renal donor patients from a radiographic database. Descriptive statistics as well as linear regression comparing variables to BMI were performed.
RESULTS: Mean BMI and age were 27.1 and 47.8, respectively. The SCIA originated from the common femoral artery in 77 cases (remainder profunda). The mean vessel diameter was 1.85mm at source vessel origin. Distance from skin to source vessel averaged 30.7mm. Supra-scarpal subcutaneous thickness averaged 16.5mm. The mean distance from Scarpa’s fascia to vessel origin was 14.1mm. Direct three-dimensional distance from vessel origin to pubic tubercle was 50.2mm. A medial and lateral perforator split off of the SCIA was observed in 38 cases. Significant differences were shown when comparing BMI to skin to source vessel distance (p<0.001), supra-Scarpal subcutaneous fat thickness (p<0.001), and fascial distance to vessel origin (p<0.001). BMI did not significantly affect vessel diameter.
CONCLUSIONS: Despite a significantly higher BMI than previously published cohorts, the SCIP flap remains an excellent source of thin and pliable tissue. When dissected closer to the source vessel, a vessel caliber of nearly 2mm can be achieved thus obviating the need for "super-microsurgery" in this population.
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